Sentinel lymph node mapping for ovarian cancer?

With all of the recent expansion of sentinel lymph node mapping for melanoma and breast cancers and now in all solid tumors, some experts are wondering about the value of this technique for ovarian cancer. A study published ahead of print Oct. 20 in the Journal of Nuclear Medicine makes the case.

Few analyses of sentinel node (SN) mapping in ovarian cancer are available due to concerns of tumor dissemination following injection of imaging agents in the cortex of the ovaries. But epithelial ovarian cancer is the top cause of death among gynecologic cancers and survival is around 25 percent for women with advanced stages of the disease, which researchers say warrants another look.

Marjolein Kleppe, MD, from the department of obstetrics and  gynecology at Maastricht University Medical Center in Maastricht, The Netherlands, and colleagues evaluated the feasibility and safety of SN mapping for ovarian cancer. Results showed that the procedure was safe for healthcare workers and “promising” for detection of metastatic disease.

“Injection of radioactive tracers resulted in the identification of SNs in all patients, suggesting that the technique could potentially be incorporated into routine clinical practice in patients with early-stage ovarian cancer,” wrote Kleppe et al. “The SN procedure could be a cost-effective method to reduce the morbidity and rate of complications associated with complete pelvic and paraaortic lymphadenectomy.”

For this study, women at high risk of malignant ovarian cancer were injected with blue dye and radioactive colloid into the proper ovarian ligament and suspensory ligament of the ovary. The surgeon, theater nurse and pathologist wore a device to read radiation exposure. A total of 21 patients underwent SN mapping and at least one involved lymph node was found in each patient.

A prospective multisite clinical trial is now in development.